Abstract：
OBJECTIVE: To assess trends in antibiotic use across a large cohort of extremely low birth-weight (<1000 g; ELBW) infants admitted to academic and community neonatal intensive care units (NICUs) across the USA over a 13-year period.
METHODS: Repeated cross-sectional cohort study.
METHODS: Premier Health Database, a comprehensive administrative database of inpatient encounters from academic and community hospitals across the US.
METHODS: ELBW inborn infants admitted to NICUs from 1 January 2009 to 31 December 2021.
METHODS: N/A MAIN OUTCOME MEASURES: Absolute and relative changes in (1) proportion of ELBW infants with antibiotic exposure and (2) days of therapy (DOT) per 1000 patient days, over time. Average annual differences were estimated using generalised linear regression with 95% CI. Disposition trends were also measured.
RESULTS: Among 36 701 infants admitted to 402 NICUs, the proportion exposed to antibiotics was essentially unchanged (89.9% in 2009 to 89.3% in 2021; absolute reduction of -0.6%); generalised linear regression estimated an annual absolute difference of -0.3% (95% CI (-0.6%) to (-0.07%); p=0.01). DOT per 1000 patient days decreased from 337 in 2009 to 210 in 2021, a 37.8% relative difference and annual relative difference of -4.3% ((-5.2%) to (-3.5%); p<0.001). Mortality was unchanged during the study period.
CONCLUSIONS: We found a substantial reduction in antibiotic DOT despite no substantive change in the proportion of infants exposed to antibiotics. This suggests the success of stewardship efforts aimed at antibiotic duration and highlight the need for improved approaches to identifying ELBW infants at highest risk of infection.
METHODS: Repeated cross-sectional cohort study.
METHODS: Premier Health Database, a comprehensive administrative database of inpatient encounters from academic and community hospitals across the US.
METHODS: ELBW inborn infants admitted to NICUs from 1 January 2009 to 31 December 2021.
METHODS: N/A MAIN OUTCOME MEASURES: Absolute and relative changes in (1) proportion of ELBW infants with antibiotic exposure and (2) days of therapy (DOT) per 1000 patient days, over time. Average annual differences were estimated using generalised linear regression with 95% CI. Disposition trends were also measured.
RESULTS: Among 36 701 infants admitted to 402 NICUs, the proportion exposed to antibiotics was essentially unchanged (89.9% in 2009 to 89.3% in 2021; absolute reduction of -0.6%); generalised linear regression estimated an annual absolute difference of -0.3% (95% CI (-0.6%) to (-0.07%); p=0.01). DOT per 1000 patient days decreased from 337 in 2009 to 210 in 2021, a 37.8% relative difference and annual relative difference of -4.3% ((-5.2%) to (-3.5%); p<0.001). Mortality was unchanged during the study period.
CONCLUSIONS: We found a substantial reduction in antibiotic DOT despite no substantive change in the proportion of infants exposed to antibiotics. This suggests the success of stewardship efforts aimed at antibiotic duration and highlight the need for improved approaches to identifying ELBW infants at highest risk of infection.
摘要：
目的：评估在13年期间美国学术和社区新生儿重症监护病房(NICU)收治的大量极低出生体重(<1000g;ELBW)婴儿的抗生素使用趋势。
方法：重复横断面队列研究。
方法：PremierHealthDatabase,来自美国各地学术和社区医院的住院患者综合管理数据库。
方法：从2009年1月1日至2021年12月31日在NICU住院的ELBW出生婴儿。
方法：不适用主要结果指标：（1）抗生素暴露的ELBW婴儿比例和（2）每1000个患者天的治疗天数（DOT）的绝对和相对变化，随着时间的推移。使用95%CI的广义线性回归估计年平均差异。还测量了处置趋势。
结果：在402个NICU的36701名婴儿中，暴露于抗生素的比例基本没有变化(2009年为89.9%,2021年为89.3%;绝对减少-0.6%);广义线性回归估计年绝对差异为-0.3%(95%CI(-0.6%)至(-0.07%);p=0.01).每1000个患者日的DOT从2009年的337个下降到2021年的210个，37.8％的相对差异和年相对差异为-4.3％（（-5.2％）至（-3.5％）；p<0.001）。死亡率在研究期间没有变化。
结论：我们发现，尽管暴露于抗生素的婴儿比例没有实质性变化，但抗生素DOT显著减少。这表明针对抗生素持续时间的管理工作取得了成功，并强调需要改进方法来识别感染风险最高的ELBW婴儿。
方法：重复横断面队列研究。
方法：PremierHealthDatabase,来自美国各地学术和社区医院的住院患者综合管理数据库。
方法：从2009年1月1日至2021年12月31日在NICU住院的ELBW出生婴儿。
方法：不适用主要结果指标：（1）抗生素暴露的ELBW婴儿比例和（2）每1000个患者天的治疗天数（DOT）的绝对和相对变化，随着时间的推移。使用95%CI的广义线性回归估计年平均差异。还测量了处置趋势。
结果：在402个NICU的36701名婴儿中，暴露于抗生素的比例基本没有变化(2009年为89.9%,2021年为89.3%;绝对减少-0.6%);广义线性回归估计年绝对差异为-0.3%(95%CI(-0.6%)至(-0.07%);p=0.01).每1000个患者日的DOT从2009年的337个下降到2021年的210个，37.8％的相对差异和年相对差异为-4.3％（（-5.2％）至（-3.5％）；p<0.001）。死亡率在研究期间没有变化。
结论：我们发现，尽管暴露于抗生素的婴儿比例没有实质性变化，但抗生素DOT显著减少。这表明针对抗生素持续时间的管理工作取得了成功，并强调需要改进方法来识别感染风险最高的ELBW婴儿。
